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KHIN: An HIE Making Progress -- and Sustainability -- Happen

In a niche powered by 564 million ONC dollars, Dr. Laura McCrary, Kansas Health Information Network’s Executive Director, stands out in leading a growth-focused HIE.

This has attracted well-justified media attention.  In a recent interview, Laura McCrary shared her main “rules of the HIE road,” and intriguing ideas on HIE sustainability.

The Kansas Health Information Network (KHIN) launched carefully, says McCrary, so its sustained impact gave it staying power statewide.  The path to today’s multi-service operation, she says, is the work of many hands. “We built this together -- we got the hospital association and the medical society together, and didn’t let the ‘perfect’ be the enemy of the good.” They quickly moved beyond that.

Now KHIN keeps on renewing itself. As more new initiatives launch, it is linking large segments of Kansas patients – over 250,000 – with providers, hospitals, clinics and community mental health centers, public health registries, even insurers. The list of stakeholders is long and impressively comprehensive.

Which KHIN key initiatives are most in the limelight?

  • Establishing a patient portal.
  • Electronic sharing of VA records from VA facilities with non-VA providers in Kansas.
  • Exchanging data with the Kansas Infectious Disease Registry, a major boost for time-sensitive Ebola-level crises.
  • Partnering on data exchanges with county mental health centers – meaning behavioral health referrals are now possible.

Its many high-visibility efforts invite comparisons with HIEs elsewhere, for instance the Delaware Health Information Network (DHIN), the first (now oldest) U.S. HIE to go live. The DHIN penetration of its provider base has resulted in 97% of Delaware’s providers linked through HIE.  Kansas, at three times the population (and 32 times the size) of Delaware, still has bragging rights given its major strides in four years.

There are technical challenges ahead that are familiar to many HIEs.  To gain ever broader usage, McCrary says, means “getting more data into our HIE, using data for quality improvement and enhancing the UI [user interface] so it better suits what physicians want” (boosting her user base). It also means serving as the transport mechanism for acute and ambulatory care with Direct messaging services.

Data export issues came up when first sharing VA records with non-VA Kansas providers (even with solid support from a technology vendor). That concern might shadow the plans for new services.  HIEs exist in a complex world, she says, clearly “a time of transitions of care and C-CDAs” so interoperability is key.  SDR (self-defined resource) integration with newer protocols like FHIR, as well as address directories for users, are just some of the needs in gaining usage.

To address some of the hurdles, KHIN turned to EHR certification, and a C-CDA (Consolidated Clinical Document Architecture) is now available to all stakeholders.

As the organization begins turning yet another page, McCrary is reviewing options for improving the organization’s sustainability.  In the future, they may well offer electronic lab reporting, immunization records and more.

Sustainability is one driver for its expanding services.  “One way to grow,” she points out, “is to offer certifications to stakeholders showing they’ve met Meaningful Use Stage 2 requirements.”  132 hospitals and 2400 providers have benefited and use KHIN for MU2 purposes.  For providers, this will also mean buying a PHR portal, if not a full EHR.

Another key is extracting smart data for quality improvement for physicians and ACOs, who want shared savings.  That means engaging the users.

Yet satisfying today’s user base is just as essential, she insists.  No one can possibly sustain themselves on user fees, she’s said many times (including at the 2014 ONC meeting in Washington). But having built out a sound platform, methodically expanding it is now KHIN’s path to the future.

Dr. McCrary’s closing reminder: “The first cellphone was big and hard to use. We’re not yet at the ‘smartphone’ stage as an HIE. But we’re committed to getting there.”

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